Provider Demographics
NPI:1558486886
Name:FUKUMOTO, JOAN HANAE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:HANAE
Last Name:FUKUMOTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:45-710 KEAAHALA RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3528
Mailing Address - Country:US
Mailing Address - Phone:808-247-2191
Mailing Address - Fax:808-236-8716
Practice Address - Street 1:45-710 KEAAHALA RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3528
Practice Address - Country:US
Practice Address - Phone:808-247-2191
Practice Address - Fax:808-236-8716
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI66732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry